States are going beyond federal requirements to detect fraud in Medicaid home care, cross-checking billed services against electronic visit verifications (EVVs) and analyzing claims for specific patterns, according to a new KFF report. Most states report that program integrity was one of their top three priorities, but the report’s authors cautioned that additional anti-fraud efforts […]
Category: Fraud
On Wednesday, a Brooklyn federal court sentenced the owner of adult day and home health companies to 76 months in prison for leading a multiyear Medicaid fraud and illegal kickback scheme that fraudulently billed the program about $64 million. The owner, Zakia Khan, pleaded guilty in 2025 to conspiring to defraud Medicaid and pay healthcare […]
As the Centers for Medicare & Medicaid Services (CMS) and Department of Justice (DOJ) intensify anti-fraud enforcement in the home health industry, established providers are focusing on reinforcing quality, documentation integrity, proactive oversight and other compliance models already in place, leaders told Home Health Care News. “Our strategy is really about making sure people understand […]
Last week, Sen. Susan Collins (R-Maine) introduced a bill that would reset the home health base payment rate and give the Centers for Medicare & Medicaid Services (CMS) new fraud-fighting tools. The bill serves as a microcosm of how lawmakers appear to view the home health industry: with equal parts support and suspicion. It’s a […]
The United States Department of Justice (DOJ) Fraud Division named home health and hospice as among its top enforcement priorities and plans to use innovative data analysis to target fraud schemes in these industries, according to a Thursday memorandum. The agency plans to further crack down on healthcare fraud by increasing the headcount of its […]
Sen. Susan Collins (R-Maine) has introduced a bill that, if enacted, would give the Centers for Medicare & Medicaid Services (CMS) additional tools to prevent and detect home health fraud and reset the Medicare home health payment rate to levels seen before years of payment cuts. The bill, called the Medicare Home Health Payment Integrity […]
The home-based care industry is shifting fast, with major leadership changes, new technologies changing the operational game and a significantly different regulatory landscape, including a federal-level fraud crackdown. Those are big, sometimes abstract forces. But what matters most is how provider leaders show up in an organization’s day-to-day operations: the referral documents someone has to […]
The United States Department of Justice (DOJ) Fraud Division, U.S. Attorney’s Office and Pennsylvania Attorney General have charged 19 defendants for a $4 million fraudulent Medicare and Medicaid scheme involving home care. The schemes involved submitting claims for home health services that never occurred or billing an exorbitant number of hours within an unrealistic period, […]
Choice Health at Home’s CEO, David Jackson, envisions his rapidly-growing business as among the largest home-based post-acute care businesses within the next five years. To achieve this goal, Jackson has laid out a strategy that includes “matching the market” in terms of Medicare Advantage, a hub-and-spoke density model and a three-pronged service foundation, according to […]
Indiana has instituted a six-month provider certification and enrollment moratorium on some home- and community-based services waiver providers after gaining approval from the Centers for Medicare & Medicaid Services (CMS). The moratorium goes into effect on Aug. 1, 2026, and is designed to mitigate fraud, waste and abuse, according to Indiana Health Coverage Programs (IHCP). […]
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